How is the number of emergency consultations organized?

condition Emergency situations in and out of hospitals In Spain, faced with a The scarcity of doctors makes its formation difficult. problem for doctors Result of “devirtualization of the original form” to meet the demands of it not respond to “technical” standards nor “population health”. Because what they expect isIt is impossible to sustain the ’emergency model’ With the current number of professional devices and departments, while encouraging simplification with redesign based Two occupational categoriesHospital emergency specialists: those in charge of the hospital and the family who attend to emergencies outside the hospital.

We’ve turned this into a A mosaic of occupational groups and emergency departments that are difficult to organize. Now that resources are scarce, they are allocated according to the pressures of one or the other, making decisions They encourage pure healthy consumption.”claims Luis Antonia Montes, President of the College of Physicians of Asturias, Head of the Emergency Service at the Central University Hospital of Asturias (HUCA) and member of the Standing Committee of the Organization of the Medical College (OMC).

For a physician, the decisions made that brought the prototype to its current configuration have no medical justification. From a technical and assistance point of view They are really irrational and do not generate value, They do not improve the health of the population and do not make citizens happier. Having medical devices around the clock in every neighborhood and hospitals within 50 kilometers is a race to a Accessibility you think is 100 percent the best and I have my doubts that it isí”, reflects Antuña Montes.

The specialist also considers that “an impossibility Maintain the number of emergency medical consultations That there is care at all levels for the various organs, especially if they do not improve the health of citizens. This is not the way to go. The system should be redirected based on technical standards and standards of care,” details the HUCA Chief of Emergency Department.

Distorted original idea

As Antuña Montes recalls, the original idea that Familia accepted with the creation of the specialty was that they would be responsible for out-of-hospital care, while in-hospital emergencies were responsible for more severe cases or if more diagnostic means were needed.

However, according to the doctor, new emergency services have popped up along the way. “061 and Samur were created as out-of-hospital services. In these years, the model was exposed to Adjustments due to political norms, collective pressure, or the discrepancy between supply and demand– says the specialist.

This caused it to switch to “17 different systems” and where Various occupational classes and devices proliferatedwho attend emergencies. The initial concept was distorted That the elementary school attended their emergencies and hospitalized them,” reflects Antonia Montes, who argues her position by recalling the creation of some services that the elementary school used to mandate, such as SUAP or SAR.

In this sense, Antonia Montes recalls that when she trained in family and community medicine, emergency care was part of the profession. “Nobody told us we were not going to be on guard duty or constant carea. It is a very important part of majoring What happened? Because of pressure and oversupply of physicians, the number of those who devoted themselves only to continuing care was established and other physicians ceased to be on guard duty. This is not normal. During one stage of your career, you must collaborate with urgent patient care and with non-appointment schedules,” the specialist claims.

Two categories to organize emergencies

To counteract the mosaic of categories, the specialist considers it “on a schematic level There should be only two occupational categories For emergency and emergency physicians. “Primary care must be organized to meet both community and out-of-hospital urgent care. There can be no professional class of primary emergency physicians who cannot compete for a family medicine position in a health center that is wrong,” warns Antonia Montes.

In this sense, the doctor understands that in terms of human resources there must be a Professional to take care of b Emergency care outside the hospital and ensuring continuity of care. while l hospital level There must be another doctor Emergencies and emergencies Designed for more complex cases.
“With these two categories we should be able to organize everything and we don’t have 14 different categories. And reliance on an out-of-hospital emergency should be primary care, something that should never have ceased to be,” explains Antonia Montes.

Worthless emergency network

Another leg to personalize the model also includes unnecessary ongoing care devices. “Maybe we have a contingency network that I suspect generates value and improve the health of citizens. They respond to the needs of groups and politicians, but not to health and technical standards.

Antuña Montes considers, for example, that among the various cities there may be a PAC and not one in each one. “The solution is not easy, but it is one thing to ensure fairness and another that we must have everything in all places. It is not a question of resources, it is about being rational and proving that all this generates value. Maybe we have one 100 percent accessibility, but does this improve population health?‘ the doctor asks.

Public awareness in emergency use

In the context of scarce resources, Antuña Montes advocates dedicating them to what would generate more value. “We must direct the investment so that the citizen can demand health care when he is a nurse and does not need to go constantly to health devices,” the doctor details.

The specialist recalls that the SNS “cannot cure everything” and “no health system” supports this. “You have to give it an idea so that citizens are aware of the need for healthy habits, Rational use of health resources, enough counselling, that they take care of themselves and that they know that happiness is not going to be achieved by more devices or by more health care that we have. We must also ask our politicians for a state pact so that this is not based on solutions based on interests,” claims Antonia Montes.